Current and emerging pharmacological therapy for nonalcoholic fatty liver disease

The main treatment of patients with non-alcoholic fatty liver disease(NAFLD) is life style modification including weight reduction and dietary regimen.Majority of patients are safely treated with this management and pharmacologic interventions are not recommended. However, a subgroup of NAFLD patients with non-alcoholic steatohepatitis(NASH) who cannot achieve goals of life style modification may need pharmacological therapy. One major obstacle is measurement of histological outcome by liver biopsy which is an invasive method and is not recommended routinely in these patients. Several medications, mainly targeting baseline mechanism of NAFLD, have been investigated in clinical trials for treatment of NASH with promising results. At present, only pioglitazone acting as insulin sensitizing agent and vitamin E as an antioxidant have been recommended for treatment of NASH by international guidelines. Lipid lowering agents including statins and fibrates, pentoxifylline, angiotensin receptor blockers, ursodeoxycholic acid, probiotics and synbiotics are current agents with beneficial effects for treatment of NASH but have not been approved yet. Several emerging medications are in development for treatment of NASH. Obeticholic acid, liraglutide, elafibranor, cenicriviroc and aramchol have been tested in clinical trials or are completing trials. Here in, current and upcoming medications with promising results in clinical trial for treatment of NAFLD were reviewed.

Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies

Rheumatoid arthritis（RA） is a chronic systemic autoimmune disease that primarily affects the lining of the synovial joints and is associated with progressive disability, premature death, and socioeconomic burdens. A better understanding of how the pathological mechanisms drive the deterioration of RA progress in individuals is urgently required in order to develop therapies that will effectively treat patients at each stage of the disease progress. Here we dissect the etiology and pathology at specific stages：（i） triggering,（ii） maturation,（iii） targeting, and（iv） fulminant stage, concomitant with hyperplastic synovium, cartilage damage, bone erosion, and systemic consequences. Modern pharmacologic therapies（including conventional, biological, and novel potential small molecule disease-modifying anti-rheumatic drugs） remain the mainstay of RA treatment and there has been significant progress toward achieving disease remission without joint deformity. Despite this, a significant proportion of RA patients do not effectively respond to the current therapies and thus new drugs are urgently required. This review discusses recent advances of our understanding of RA pathogenesis, disease modifying drugs, and provides perspectives on next generation therapeutics for RA.

The dorsal root ganglion as a target for neurorestoration in neuropathic pain

Neuropathic pain is a severe and chronic condition widely found in the general population.The reason for this is the extensive variety of damage or diseases that can spark this unpleasant constant feeling in patients.During the processing of pain,the dorsal root ganglia constitute an important region where dorsal root ganglion neurons play a crucial role in the transmission and propagation of sensory electrical stimulation.Furthermore,the dorsal root ganglia have recently exhibited a regenerative capacity that should not be neglected in the understanding of the development and resolution of neuropathic pain and in the elucidation of innovative therapies.Here,we will review the complex interplay between cells(satellite glial cells and inflammatory cells)and factors(cytokines,neurotrophic factors and genetic factors)that takes place within the dorsal root ganglia and accounts for the generation of the aberrant excitation of primary sensory neurons occurring in neuropathic pain.More importantly,we will summarize an updated view of the current pharmacologic and nonpharmacologic therapies targeting the dorsal root ganglia for the treatment of neuropathic pain.

Pharmacological therapy for stable chronic obstructive pulmonary disease

In recent years,emphasis has shifted from preventing and treating chronic obstructive pulmonary disease(COPD)to early prevention,early treatment,and disease stabilization,with the main goal of improving patients’quality of life and reducing the frequency of acute exacerbations.This review summarizes pharmacological therapies for stable COPD.

Pharmacological treatments of presbyopia:a review of modern perspectives

Introduction:Presbyopia affects people from the 4^(th) decade of life and is characterized by accommodative loss that leads to negative effects on vision-targeted health-related quality of life.A non-invasive pharmacological treatment providing near-lenses independence would be a truly groundbreaking approach in the treatment of presbyopia.The purpose of this review is to analyze the emerging pharmacological solutions proposed to address presbyopia.Results:Several ophthalmic eye drops compounds solutions have been described in peer-reviewed papers or presented in ophthalmological tabloids and congresses.Each topical treatment deals with drug combinations aimed to modify one or more factors involved in the accommodative process and have been proposed to be instilled either monocularly or binocularly.It remains unclear how much each drug in the final combined form is involved in the achievement of the outcome and contributes to it.Conclusion:Despite the lack of a completely well understood mechanism,pharmacological control of presbyopia seems to be a possible and very attractive alternative for presbyopic patients.The studies mentioned in this review are to be considered pilot investigations as they involve either a small number of subjects or are single case series.Complete studies are needed to confirm which will be the more effective pharmacological compound for the treatment of presbyopia.

The novel pharmacological treatment in hypertrophic cardiomyopathy

Background Hypertrophic cardiaomyopathy（HCM） is characterized by asymmetric myocardial hypertrophy, mainly involving ventricular septum. Current treatment methods for HCM include drugs, interventional and surgical procedures. The β-blockers and calcium antagonists-verapamil, which increase the diastolic filling time and improve ventricular diastolic function, are most commonly used. However, there are some limitations and side effects of these drugs. This article summarizes the current advances in drug therapy for HCM and reviews the latest literatures, clinical guidelines and the current clinical most commonly used treatment of HCM drugs and the latest research progress. While improving clinical symptoms of HCM, the drugs could reverse myocardial hypertrophy, reduce the pressure gradient and improve the prognosis need further in-depth study.

Current strategies for the treatment of inborn errors of metabolism

Inborn errors of metabolism（IEMs） are a large group of inherited disorders characterized by disruption of metabolic pathways due to deficient enzymes, cofactors, or transporters. The rapid advances in the understanding of the molecular pathophysiology of many IEMs, have led to significant progress in the development of many new treatments. The institution and continued expansion of newborn screening provide the opportunity for early treatment, leading to reduced morbidity and mortality. This review provides an overview of the diverse therapeutic approaches and recent advances in the treatment of IEMs that focus on the basic principles of reducing substrate accumulation, replacing or enhancing absent or reduced enzyme or cofactor, and supplementing product deficiency. In addition, the challenges and obstacles of current treatment modalities and future treatment perspectives are reviewed and discussed.